Single-staged resections and 3D reconstructions of the nasion, glabella, medial orbital wall, and frontal sinus and bone: Long-term outcome and review of the literature

Abstract

Background: Aesthetic facial appearance following neurosurgical ablation of frontal fossa tumors is a primary concern for patients and neurosurgeons alike. Craniofacial reconstruction procedures have drastically evolved since the development of three-dimensional computed tomography imaging and computer-assisted programming. Traditionally, two-stage approaches for resection and reconstruction were used; however, these two-stage approaches have many complications including cerebrospinal fluid leaks, necrosis, and pneumocephalus.

Case description: We present two successful cases of single-stage osteoma resection and craniofacial reconstruction in a 26-year-old female and 65-year-old male. The biopolymer implants were preselected and contoured based on imaging prior to surgery. The ideal selection of appropriate flaps for reconstruction was imperative. The flaps were well vascularized and included a pedicle for easy translocation. Using a titanium mesh biopolymer implant for reconstruction in conjunction with a forehead flap proved advantageous, and the benefits of single-stage approaches were apparent. The patients recovered quickly after the surgery with complete resection of the osteoma and good aesthetic appearance. The flap adhered to the biopolymer implant, and the cosmetic appearance years after surgery remained decent. The gap between the bone and implant was less than 2 mm. The patients are highly satisfied with the symmetrical appearance of the reconstruction.

Conclusions: Advances in technology are allowing neurosurgeons unprecedented opportunities to design complex yet feasible single-stage craniofacial reconstructions that improve a patient's quality of life by enhancing facial contours, aesthetics, and symmetry.

Keywords: Biopolymers; craniofacial reconstruction; implants; osteoma; single-stage approach.

Figure 1

Osteoma involving the frontal sinus, nasion, glabella, and medial orbital wall in a 26-year-old female

Figure 2

Three-dimensional skull model to aid in surgical planning

Figure 3

Single staged resection and three-dimensional reconstruction: Osteoma involving the frontal sinus, nasion, glabella, and medial orbital wall in a 26-year-old female

Figure 4

Postoperative picture showing good cosmetic outcome

Figure 5

Osteoma involving the medial orbital wall, nasion, glabella, frontal bone and sinus, ethmoids, cribriform with displacement of the medial rectus and optic nerve

Figure 6

Complete total resection of the osteoma using a combined endonasal endoscopic approach with bifrontal craniotomy

Figure 7

Combined endoscopic endonasal and bifrontal craniotomy with preoperative custom three-dimensional reconstruction

Figure 8

Combined endoscopic endonasal and bifrontal craniotomy with single staged custom three-dimensional reconstruction at 2 weeks postoperatively